Praktijkonderzoek over integratie van practice based evidence en evidence based practice, nderzoeksresultaten toepassen in de praktijk,verbeteren in en door de praktijk.
This thesis describes an Action Research (AR) project aimed at the implementation of Evidence Based Practice in a mental health nursing setting in the Netherlands. The main research question addressed in this thesis is: In what way is Action Research with an empowering appropriate to implement Evidence Based Practice in a mental health nursing setting in the Netherlands and what is the effect of this implementation on the care experienced by the client, the nursing interventions and the context in this setting compared to a comparative setting? To answer this main research question, the following questions derived from it were addressed: What is Evidence Based Practice? What is known about implementing evidence-based practice in nursing through Action Research? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be more successful? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be successful? How is EBP implemented through AR with an empowering intent and what are the outcomes for the use of evidence, the context and the facilitation in the setting? What is the effect of the implementation of EBP in mental health nursing using AR with an empowering intent on the care experienced by the client, the nursing interventions and the context compared to a comparison setting? The first two questions were answered by a search of the literature while the remaining questions were answered during the AR study conducted in two mental health organisations in the Netherlands.
Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action research. Method: The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. Results: A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of EBP were that nurses had little knowledge of EBP and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of EBP was adapted. Nurses worked according to the EBP discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Conclusions: Action research provides an opportunity to empower nurses and to tailor EBP to the practice context. Applying and implementing EBP is difficult for front-line nurses with limited EBP competencies. Relevance to clinical practice: Adaptation of the academic model of EBP to a more pragmatic approach seems necessary to introduce EBP into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice, it seems relevant to integrate scientific evidence with clinical expertise and patient values in nurses’ clinical decision making at the individual patient level.
Voldoende bewegen is van belang voor iedereen, maar bij uitstek voor patiënten met chronische aandoeningen. Draagbare beweegsensoren bieden veel potentie om beweeggedrag van deze patiënten effectief te stimuleren binnen de eerstelijns zorg en revalidatiecentra. Zorgprofessionals erkennen die potentie, met name voor het creëren van bewustzijn van beweeggedrag bij hun patiënten en om gerichte feedback te geven. Echter ervaren de zorgprofessionals moeite bij het gebruik van beweegsensoren; bijvoorbeeld bij het instellen, uitlezen en interpreteren van de data. Ze geven aan kennis en vaardigheden te missen om de beweegsensoren doelgericht in te kunnen zetten, en passen het dan ook maar weinig toe. Dit terwijl de zorgprofessionals cruciale schakels zijn in de steeds evidenter wordende noodzaak van toepassing van technologie in de zorg. Momenteel bestaan er nog geen standaard richtlijnen, werkwijzen of een andere vorm van ondersteuning om beweegsensoren doelgericht en effectief in te zetten. De onderzoeksvraag die wordt beantwoord in dit project is: “Hoe kunnen professionals in de beweegzorg, werkzaam in de 1e lijn en revalidatiecentra, ondersteund worden bij het doelgericht inzetten van technologie voor het meten en stimuleren van beweeggedrag bij patiënten met chronische aandoeningen?” Deze onderzoeksvraag wordt opgelost door middel van een ontwerpgericht onderzoek, waarin een Evidence-Based-Practice methodiek wordt ontwikkeld die zorgprofessionals ondersteunt bij het inzetten van beweegsensoren. De eerste fase (problem finding) in het ontwerpgerichte onderzoek richt zich op wat er ontwikkeld gaat worden, o.a. aan de hand van stakeholder-mapping, best practices, en het opstellen van een plan van eisen & wensen. De tweede fase (solution finding) richt zich op het ontwikkelen van de methodiek, door middel van co-creatie ontwerpsessies met de stakeholders. In deze fase wordt een prototype ontwikkeld dat in de praktijk getest en geëvalueerd gaat worden. In beide fasen en in elke stap wordt de praktijk betrokken door middel van focusgroepen, groepsbijeenkomsten en expert raadpleging.
The project aims to improve palliative care in China through the competence development of Chinese teachers, professionals, and students focusing on the horizontal priority of digital transformation.Palliative care (PC) has been recognised as a public health priority, and during recent years, has seen advances in several aspects. However, severe inequities in the access and availability of PC worldwide remain. Annually, approximately 56.8 million people need palliative care, where 25.7% of the care focuses on the last year of person’s life (Connor, 2020).China has set aims for reaching the health care standards of the developed countries by 2030 through the Healthy China Strategy 2030, where one of the improvement areas in health care includes palliative care, thus continuing the previous efforts.The project provides a constructive, holistic, and innovative set of actions aimed at resulting in lasting outcomes and continued development of palliative care education and services. Raising the awareness of all stakeholders on palliative care, including the public, is highly relevant and needed. Evidence based practice guidelines and education are urgently required for both general and specialised palliative care levels, to increase the competencies for health educators, professionals, and students. This is to improve the availability and quality of person-centered palliative care in China. Considering the aging population, increase in various chronic illnesses, the challenging care environment, and the moderate health care resources, competence development and the utilisation of digitalisation in palliative care are paramount in supporting the transition of experts into the palliative care practice environment.General objective of the project is to enhance the competences in palliative care in China through education and training to improve the quality of life for citizens. Project develops the competences of current and future health care professionals in China to transform the palliative care theory and practice to impact the target groups and the society in the long-term. As recognised by the European Association for Palliative Care (EAPC), palliative care competences need to be developed in collaboration. This includes shared willingness to learn from each other to improve the sought outcomes in palliative care (EAPC 2019). Since all individuals have a right to health care, project develops person-centered and culturally sensitive practices taking into consideration ethics and social norms. As concepts around palliative care can focus on physical, psychological, social, or spiritual related illnesses (WHO 2020), project develops innovative pedagogy focusing on evidence-based practice, communication, and competence development utilising digital methods and tools. Concepts of reflection, values and views are in the forefront to improve palliative care for the future. Important aspects in project development include health promotion, digital competences and digital health literacy skills of professionals, patients, and their caregivers. Project objective is tied to the principles of the European Commission’s (EU) Digital Decade that stresses the importance of placing people and their rights in the forefront of the digital transformation, while enhancing solidarity, inclusion, freedom of choice and participation. In addition, concepts of safety, security, empowerment, and the promotion of sustainable actions are valued. (European Commission: Digital targets for 2030).Through the existing collaboration, strategic focus areas of the partners, and the principles of the call, the PalcNet project consortium was formed by the following partners: JAMK University of Applied Sciences (JAMK ), Ramon Llull University (URL), Hanze University of Applied Sciences (HUAS), Beijing Union Medical College Hospital (PUMCH), Guangzhou Health Science College (GHSC), Beihua University (BHU), and Harbin Medical University (HMU). As project develops new knowledge, innovations and practice through capacity building, finalisation of the consortium considered partners development strategy regarding health care, (especially palliative care), ability to create long-term impact, including the focus on enhancing higher education according to the horizontal priority. In addition, partners’ expertise and geographical location was also considered important to facilitate long-term impact of the results.Primary target groups of the project include partner country’s (China) staff members, teachers, researchers, health care professionals and bachelor level students engaging in project implementation. Secondary target groups include those groups who will use the outputs and results and continue in further development in palliative care upon the lifetime of the project.
Bij de reclassering is professioneel handelen en besluitvorming gebaseerd op actuele vakkennis. Ook wordt steeds meer afgestemd met cliënten. Dit sluit aan bij de principes van evidence-based practice (EBP): de expertise van de professional, wetenschappelijke kennis en cliëntervaringen vormen samen de input voor het nemen van weloverwogen besluiten. De reclassering heeft al verscheidene stappen gezet richting een EBP maar ervaart diverse knelpunten in de uitvoering ervan. Reclasseringswerkers vinden het bijvoorbeeld moeilijk om op een adequate manier de verbinding te leggen tussen theorie en praktijk. Daarbij vinden ze het lastig om, vanwege het gedwongen kader, de meningen van cliënten te betrekken.Doel Bijdragen aan het doorontwikkelen van de reclasseringspraktijk naar een EBP. Resultaten Vijf teams van de reclasseringsorganisaties (3RO) voeren het onderzoeksproject uit. Zij vormen samen met onderzoekers en (ex-)cliënten zogenoemde ‘ontwikkelwerkplaatsen’ waarin zij nieuwe werkwijzen ontwikkelen, evalueren en bijstellen. Onderzocht wordt of deze nieuwe werkwijzen leiden tot veranderingen in opvattingen en gedrag bij reclasseringswerkers en het functioneren van cliënten. Ook evalueren we in hoeverre het versterken van EBP bijdraagt aan recidivebeperking en re-integratie van cliënten. Looptijd 01 november 2022 - 08 januari 2026 Aanpak Analyse van het ontwikkelproces in de teams Effectmeting op strafrechtelijke recidive en re-integratie van cliënten Herhaalde metingen: • Interviews met beleidsmedewerkers, reclasseringswerkers, leidinggevenden, (evt.) werkbegeleiders en cliënten, incl. controleteams • Geluidsopnames van toezichtgesprekken • Gestructureerde observatie van casuïstiekbesprekingen • Verslaglegging van bijeenkomsten in ontwikkelwerkplaatsen
